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Caring for people with impaired mobility
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Rowena Slope, Katherine Hopkinson
Pressure ulcers can occur anywhere on the body. Pressure ulcers can be caused by the weight of the body or persistent contact with a medical device, or shearing and friction forces associated with poor manual handling. The most vulnerable areas of skin are around bony prominences, especially if they are in contact with hard surfaces such as an operating table or standard hospital mattress. People nursed in the supine position may develop pressure ulcers on the back of the heels and ankles; the area around the buttocks (ischial tuberosity), the elbows and shoulder blades, and the occiput (back of the head) (EPUAP 2015). Individuals nursed in the prone position are vulnerable to pressure ulcers on the toes, knees, hips, elbows and ribs (EPUAP 2015). Stephen-Haynes and Maries (2020) recommend the use of specialist equipment, silicone padding, careful positioning, and close attention to skin care for people nursed in the prone position. Wheelchair-bound individuals are at risk of developing pressure sores on their buttocks, spine, elbows, heels, back of the knees, palms and genitals (Stephens and Bartley 2018). Comprehensive assessments and care plans should be carried out for wheelchair users and their carers, which include equipment, positioning, cushions, and environment (Stephens and Bartley 2018). Medical devices and associated lines and tubes may cause pressure injuries wherever they are in contact with the skin (NPIAP 2020).
Ards Treatment
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Bruck Or, Kodela Jennifer, Kopec Scott
There are non-ventilatory methods that have been proven to be effective or show promise in the treatment of ARDS. Use of the prone position will improve survival in patients with severe ARDS (P/F ratio <150) [9]. Although, use of muscle relaxants (cis-atracurium) was effective in one prospective study in improving 90-day survival, the doses that were used were quite high, and an effect on the survival curve was not apparent until day 20 [10]. The utility of corticosteroids is controversial, and data are conflicting. Interventions that should be considered rescue therapies include inhaled nitric oxide or epoprostenol and veno-venous extracorporeal life support.
Assessment of motor behaviour while prone
Published in Mijna Hadders-Algra, Kirsten R. Heineman, The Infant Motor Profile, 2021
Mijna Hadders-Algra, Kirsten R. Heineman
In general, the infant’s self-generated motor behaviour in the prone position is assessed for several minutes. In contrast to assessment in the supine position, the assessor may immediately start to interact with the infant in order to promote the self-generated movements of the infant. The minimum time needed for the assessment of the prone position items in infants who do not locomote while prone is one minute. In young infants and infants with neurological impairment, the duration of the prone assessment may be limited due to the infant’s difficulties in lifting his head. As prolonged positioning in the prone position may be too stressful for these infants, it is better to assess prone behaviour by means of two or three stretches of 20 to 30 seconds in the prone position, which are alternated with periods in the supine position. In infants with limited capacity to lift their heads, head lifting may be promoted by positioning the assessor’s or caregiver’s face vis-a-vis the infant’s head. Presentation of an adult person’s face is more effective in attracting the young infant’s interest than the presentation of a toy as infants have an innate preference for human faces (Johnson et al. 2015). The caregiver or the assessor verbally encourages the infant to look up.
Effect of COVID-19 on the incidence of postintubation laryngeal lesions
Published in Baylor University Medical Center Proceedings, 2023
Madison Buras, Nicole DeSisto, Randall Holdgraf
As previously mentioned, studies have shown that COVID-positive patients have increased risk factors for tissue damage. However, because increased risk of vocal fold injury in our study was associated directly with pronation rather than COVID infection, early laryngoscopy may be generalized to patients who undergo pronation therapy for other reasons. Pronation describes the act of placing a ventilated patient face down. It is not an uncommon maneuver, and in a multicenter randomized controlled trial by Guérin et al, it was shown to decrease the mortality of patients with acute respiratory distress syndrome from 32.8% to 16% in a 28-day period.13 Benefits from the prone position have been well described by many studies. These benefits include mobilizing secretions from the posterior lung fields, which allows for increased alveolar recruitment in those regions, thereby improving ventilation.14 However, pronation therapy has risks. Repositioning the patient can cause the endotracheal tube to shift or dislodge. Movement of the endotracheal tube and the increased pressure that pronation causes on areas such as the posterior commissure can increase the risk of laryngeal trauma. According to the American Thoracic Society, the benefits of pronation therapy outweigh the potential adverse events, so it recommends that patients with acute respiratory distress syndrome be positioned face down for 12 to 16 hours a day.14
Interfacility Transport of Mechanically Ventilated Patients with Suspected COVID-19 in the Prone Position
Published in Prehospital Emergency Care, 2023
Andy Pan, Michael Peddle, Patrick Auger, Daryl Parfeniuk, Russell D. MacDonald
Patients with severe respiratory failure and ARDS may be candidates for more advanced therapies, such as extracorporeal membrane oxygenation (ECMO), and may need to be transferred to specialty centers to obtain these therapies. Given the utility of prone positioning, as well as the increased prevalence of severe respiratory failure and ARDS due to COVID-19, transporting the patient in the prone position may be a useful therapy (7, 8). This poses a challenge to transport agencies who are not accustomed to managing ventilated patients in the prone position. The transport setting poses unique risks not commonly encountered in the hospital, including the confined space in aircraft or land ambulance, increased risk of line and tube dislodgement during movements in and out of transport vehicles, and the inability to ‘de-prone’ a patient in a moving vehicle should an emergency arise. There is a paucity of information regarding the interfacility transport of mechanically ventilated patients in the prone position.
Lung and diaphragm protective ventilation: a synthesis of recent data
Published in Expert Review of Respiratory Medicine, 2022
Vlasios Karageorgos, Athanasia Proklou, Katerina Vaporidi
Placing the patients in a prone position was first suggested in 1974 [7] with the rationale that the collapsed dorsal areas of the lung would expand and gas exchange would improve. Indeed, in the supine position gravitational forces reduce alveolar inflation in a larger part of lung tissue mass, located dorsal, while in prone position the dorsal lung tissue is suspended along a relatively larger horizontal dorsal chest wall area than in supine position, resulting in more uniform end-expiratory lung volume and alveolar size, allowing a more equal distribution of stress and strain [47]. Moreover, ventilation-perfusion matching is better in prone than in supine position, both in healthy and in injured lungs [47,48]. Therefore, prone position can help achieve lung protective ventilation while simultaneously improving gas exchange.